Cardiac catheterization is underutilized after in-hospital cardiac arrest.
BACKGROUND
Indications for immediate cardiac catheterization in cardiac arrest survivors without ST elevation myocardial infarction (STEMI) are uncertain as electrocardiographic and clinical criteria may be challenging to interpret in this population. We sought to evaluate rates of early catheterization after in-hospital ventricular fibrillation (VF) arrest and the association with survival.


METHODS
Using a billing database we retrospectively identified cases with an ICD-9 code of cardiac arrest (427.5) or VF (427.41). Discharge summaries were reviewed to identify in-hospital VF arrests. Rates of catheterization on the day of arrest were determined by identifying billing charges. Unadjusted analyses were performed using Chi-square, and adjusted analyses were performed using logistic regression.


RESULTS
One hundred and ten in-hospital VF arrest survivors were included in the analysis. Cardiac catheterization was performed immediately or within 1 day of arrest in 27% (30/110) of patients and of these patients, 57% (17/30) successfully received percutaneous coronary intervention. Of those who received cardiac catheterization the indication for the procedure was STEMI or new left bundle branch block (LBBB) in 43% (13/30). Therefore, in the absence of standard ECG data suggesting acute myocardial infarction, 57% (17/30) received angiography. Patients receiving cardiac catheterization were more likely to survive than those who did not receive catheterization (80% vs. 54%, p<.05).


CONCLUSIONS
In patients receiving cardiac catheterization, more than half received this procedure for indications other than STEMI or new LBBB. Cardiac catheterization was associated with improved survival. Future recommendations need to be established to guide clinicians on which arrest survivors might benefit from immediate catheterization.
Merchant
Raina M
RM
The Robert Wood Johnson Clinical Scholars Program, University of Pennsylvania, School of Medicine, Philadelphia, PA 19104, United States. raina.merchant@uphs.upenn.edu
Abella
Benjamin S
BS
Khan
Monica
M
Huang
Kuang-Ning
KN
Beiser
David G
DG
Neumar
Robert W
RW
Carr
Brendan G
BG
Becker
Lance B
LB
Vanden Hoek
Terry L
TL
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization / Q000706:statistics & numerical data*; D005260:Female; D006323:Heart Arrest / Q000628:therapy*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014693:Ventricular Fibrillation / Q000628:therapy